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General NPI Number Information
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NPI Number | 1003621202
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Entity Type | Organization
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Legal Business Name | CARENCIA LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1215 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-3113
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Country | US
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Telephone | 682-478-5333
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Fax | 682-499-7705
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Provider Business Mailing Address
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Address Line | PO BOX 121592
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City | ARLINGTON
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State | TX
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Zip | 76012-1592
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Country | US
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Telephone | 682-478-5333
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Fax | 682-499-7705
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JESSE TUCKER
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Credential | APRN
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Telephone | 817-478-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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